What are Migraine Headaches?

Migraine headaches explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Migraines HeadachesMigraine headaches are categorized as a primary headache disorder. They can occur on a number of days per month, and often several times in a single day. The main symptoms are severely painful headaches (usually termed episodes), with throbbing in a particular area in the head. Migraines are often accompanied by nausea or vomiting, and with adverse reactions to light. This can also occur in response to sounds and even odors. Migraines can last for many hours, and there are even reports of migraines that persist for days.

Many researchers agree that migraines follow a system of stages, or phases. The prodromal phase takes place before an attack of migraine-related pain. It has been claimed to occur as long as 24 hours prior to a migraine episode. This phase can include changes of mood, lack of energy, inappropriate yawning, and frequent need to go to the bathroom. The next stage, the aura phase, is associated with neurological symptoms that herald the arrival of a full-blown migraine episode. These symptoms include visual disturbances, i.e. the appearance of sharp lines in the field of vision, and anomalies in sensation, speech, or movement. Most individuals with migraine headaches never experience auras, however. The attack phase is the onset of a migraine episode. Patients may experience the pain and symptoms as above, which can also extend into lightheadedness, blurry vision, and even loss of consciousness. An attack phase usually lasts a few hours, (though attacks lasting days have been reported) unless treatment administered is effective. The last stage is the postdromal phase. Fatigue, drowsiness, and occasional euphoria are associated with this phase.

Migraine Headache DiagramMigraine headaches are reported as the most common of all headache complaints; they affect approximately 12% of the U.S. population. Women are three times more likely to experience migraine pain in their lives than are men. For some women, the onset of migraine episodes is strongly associated with the course of their menstrual cycles. Migraine headaches are known as a primary disorder, which means the pain and symptoms are a discrete condition, and not linked to another underlying condition such as a brain aneurysm or tumor. Nonetheless, it is prudent to consider seeking medical attention if a migraine headache is unprecedented or unusually severe. Atypical aura-like symptoms as above, and other abnormal neurological events, such as dizziness, sudden clumsiness, changes in vision, personality switches, or mood swings, should also be taken as warning signs. If headache pain causes sudden arousal from sleep, or inability to sleep, also consider seeking medical help. Symptoms commonly associated with meningitis, such as neck stiffness, or a headache with a rash or fever, should be brought to the attention of your doctor. Emergency attention should also be sought in the event of headache pain caused by an accident or injury, particularly if it involves any sort of head trauma.

Causes of Migraine Headaches

Headaches are commonly regarded as pain emanating from the brain. This is not in fact true, as the brain itself does not contain receptors for painful stimuli. Headaches are more a result of irritation (mild chemical damage) of the many structures and membranes around or near the brain, including muscles, nerves, blood vessels, skull linings, and sensory tissue of the skull (including that of the ears and eyes). The cause of migraine headaches is not fully understood as yet. Until recently, scientists associated migraine pain with vascular abnormalities, i.e. changes in the diameter of the blood vessels around the brain. A newer theory links the tendency to develop migraine headaches with a genetic variation that affects certain structures in the brain or skull.

Migraine headaches are associated with a variety of triggers and factors, which may include genetics. A physician may have to ask a range of questions in order to diagnose a case of migraine headaches, including any family history of the disorder, symptoms and nature of an episode onset, and other variables. This is due to the fact that migraine symptoms are often experienced in other headache disorders as well, and patient reports are the most common and reliable source of a diagnosis of migraine. Some of the most common triggers of migraine headaches are psychological factors such as stress and fatigue; sleep disturbances or deprivation; reactions to chemicals such as preservatives in certain food and beverages; caffeine; a change in the outdoor environment; menstruation; and nutritional disturbances, such as not eating regularly or healthily.

Treatment for Migraine Headaches

There are many options currently available for the treatment of migraine headaches. The first line of defense is often over-the-counter (OTC) analgesics. In fact, the leading cause of OTC medication purchases in the U.S. is their use in relief from migraine pain. Prescription-free painkillers commonly recommended for migraine headaches include aspirin, ibuprofen, and acetominaphen. Non-steroidal anti-inflammatory drugs (NSAIDs) are also prescribed for migraine headaches. Symptom tracking, in which patients keep a record of migraine episode onset, pain severity, and prodromal-phase events, is also useful in management of this condition. It can help the sufferer control the condition because they can identify triggers in order to avoid them in the future. It can also alert a physician to sudden exacerbation of symptoms, which may indicate the presence of another emerging illness in addition to migraine.

Biofeedback training is an alternative, non-drug treatment that is associated with some relief in headache conditions. These techniques help patients to identify triggers and the first stages of a migraine episode. When this is achieved, they can then apply relaxation and coping techniques that may help control the severity of migraine headaches. It is reported that biofeedback training can play a role in stopping a migraine episode at its onset.

If the previous options fail, and the migraine pain is very severe and treatment-resistant, minimally-invasive medical procedures can be considered. These techniques work by blocking, or temporarily inhibiting, the nerves involved in pain signaling from sending their messages to the brain. These procedures include radiofrequency ablation, nerve blocks, and epidural steroid injections. A thorough discussion of the risks and benefits of these procedures with a physician or pain specialist is necessary to determine whether they are appropriate and safe to use in a case of migraine headaches.

Conclusion

Migraine headaches affect just over one in ten U.S. adults. Migraines are recurrent and episodic, causing extreme, throbbing pain felt in the head. The exact cause of migraine headaches is not completely understood; the most prominent theory is that they are linked to genetic susceptibility. Migraines as a primary disorder are not fatal, but atypical migraine-like symptoms can be a cause for concern. If severe abnormal symptoms occur, contacting a medical professional is recommended. There are a range of treatment options associated with relief from migraine headache pain, prescribed based on the severity and persistence of symptoms. A patient suffering from migraine headaches is advised to discuss their pain and other symptoms (and their frequency) with their doctor or pain specialist to achieve the best possible outcome.

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References

  1. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E, Quality Standard Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-53.
  2. Rapoport AM. Acute treatment of migraine: Established and emerging therapies. Headache. 2012;52(Suppl2):60-4.
  3. Rapoport AM. The therapeutic future in headache. Neurol Sci. 2012;33(Suppl 1):S119-25.
  4. Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: A review of the evidence and potential implications for management. Cephalalgia. 2012;32(10):785-95.
  5. Shapiro RE. Preventive Treatment of Migraine. Headache. 2012;52(Suppl 2):65-9.
  6. Silberstein SD. Treatment recommendations for migraine. Nat Clin Pract Neurol. 2008;4(9):482-9.
  7. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E, Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337-45.